Wikipedia:Featured article candidates/Beta-Hydroxy beta-methylbutyric acid/archive3

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was archived by Sarastro1 via FACBot (talk) 21:00, 13 February 2017 [1].

Beta-Hydroxy beta-methylbutyric acid

Nominator(s): Seppi333 (Insert 2¢) and Boghog (talk) 17:36, 1 January 2017 (UTC)[reply]

This article is about a medical food ingredient and dietary supplement that is a natural product in humans and has medical and athletic performance-enhancing applications for preventing/reversing muscle wasting and improving body composition.

This is the second pharmacology article that I've worked on for FA status. My first pharmacology FA was amphetamine, so this article's layout and formatting mirror that article. Like amphetamine, this article includes citations in the lead. I will not remove these because many of these statements are medical claims; however, I'm amenable to moving the citations into a note at the end of each paragraph as was done in the lead of amphetamine if reviewers of this nomination prefer this approach.

The labels in the section headers and their organization in the article follows MOS:PHARM and MOS:MED#Drugs, treatments, and devices. The sources used to cite medical claims in this article are required to satisfy WP:MEDRS; most, if not all, of the WP:PAYWALLED medical reviews that are currently cited in the article are and will be temprorarily available in this link for viewing/downloading to allow reviewers to conduct WP:V checks for the duration of this nomination and any subsequent FAC nominations. The file names (without the .pdf extension) of the papers listed in this link reflect the reference names (i.e., <ref name="...">) defined in the source code of the HMB article. Seppi333 (Insert 2¢) 17:36, 1 January 2017 (UTC)[reply]

Comments by Doc James

Moved from Talk:Beta-Hydroxy beta-methylbutyric acid § Follow-up from FAC

The discussion in this tab was imported from the HMB talk page

The review you are using comes to three sentences of conclusions

"HMB contributed to preservation of muscle mass in older adults." which says it help keep mm mass, does not comment on those with sarcopenea.

"HMB supplementation may be useful in the prevention of muscle atrophy induced by bed rest or other factors." A decrease of uncertainty

"Further studies are needed to determine the precise effects of HMB on muscle strength and physical function in older adults." Means it is unclear if HMB affects str or function. Doc James (talk · contribs · email) 03:04, 17 December 2016 (UTC)[reply]

IMO before we should be uneqivacally recommending this stuff in WP's voice I would like to see (1) government sources supporting benefit (2) specific reviews supporting benefit (which we have some of) and (3) general reviews supporting benefit. I do not see us as having either 1 or 3. Doc James (talk · contribs · email) 03:09, 17 December 2016 (UTC)[reply]

2017 general review on sarcopinea says "A recent meta-analysis revealed some benefit of using a combined approach of dietary supplements and exercise, but the findings were inconsistent among various populations." PMID:27886695

Based on this 2015 review [2] "The main message is that enhanced benefits of exercise training, when combined with dietary supplementation, have been shown in some trials – indicating potential for future interventions, but that existing evidence is inconsistent." Doc James (talk · contribs · email) 03:30, 17 December 2016 (UTC)[reply]

@Doc James: I've used more or less the exact wording from the meta-analysis' actual conclusion, as opposed to the abstract, in the lead in this edit. The body of the article already stated the part of the sentence that I added to the lead. This link will take you to the full text of the meta-analysis if you want to read the full conclusion.

"Further studies are needed to determine the precise effects of HMB on muscle strength and physical function in older adults." Means it is unclear if HMB affects str or function. Yes, I agree that what you stated is what that sentence means. The article didn't contradict this assertion before and it still doesn't now. The body of the article repeated that same assertion using different language at the time that you wrote this comment. I added the statement to the lead since you mentioned it.
IMO before we should be uneqivacally recommending this stuff in WP's voice I would like to see (1) government sources supporting benefit (2) specific reviews supporting benefit (which we have some of) and (3) general reviews supporting benefit. - we are not and have not been recommending anything. The article makes statements about efficacy in older adults based upon a meta-analysis. In the body of the article only, it states that the authors of two reviews have recommended it. If there are reviews that do not recommend it, we can state that too.
Re (1): why can't we just state that no governmental health agencies have endorsed the use of HMB?

Re (3): what is a "general review"?
Based on this 2015 review [3] "The main message is that enhanced benefits of exercise training, when combined with dietary supplementation, have been shown in some trials – indicating potential for future interventions, but that existing evidence is inconsistent." - this is consistent with what the meta-analysis states about the combination of exercise+HMB: "While effects on muscle mass were consistent, outcomes for muscle strength and physical performance varied in different reports. Perhaps resistance exercise in combination with HMB treatment is a potent stimulus for muscle improvement. Further studies are needed to investigate the combination of HMB and exercise for improving muscle strength and physical performance." Both reviews appear to support the assertion that "the effects of HMB combined with exercise on muscle strength and performance require further research in older adults", so would you like to see this statement added?
2017 general review on sarcopinea says "A recent meta-analysis revealed some benefit of using a combined approach of dietary supplements and exercise, but the findings were inconsistent among various populations." PMID:27886695 - this review cites this review which did not conduct a meta-analysis (quote from methodology: The studies were not graded for quality; no attempt at a meta-analysis was made.) but cited this meta-analysis when stating "A meta-analysis of findings from randomized controlled trials has shown that protein supplementation during an exercise training program increases gains in muscle mass and strength, in younger (<50 years) and older (≥50 years) adults16 – much less is known about the combined effects of exercise training and supplementation with other dietary components that have been linked to sarcopenia." That meta-analysis doesn't mention HMB anywhere. Seppi333 (Insert 2¢) 08:37, 17 December 2016 (UTC)[reply]

Just reade a few changes (diff) that i think reflect the refs and put the body and lead in harmony... calibration is very tricky here. are there outstanding issues? Jytdog (talk) 08:42, 18 December 2016 (UTC)[reply]

I'm ok with the changes you made relative to medical foods. Since the efficacy for sarcopenia has been such a major point of conflict, I think we should use language which is as close to the source as possible without creating a copyvio from paraphrasing too closely. Seppi333 (Insert 2¢) 19:36, 19 December 2016 (UTC)[reply]

@Doc James: Can you respond to my questions from above? Also, please let me know if you think Jytdog's and my changes to the first three sentences in the lead resolve the issues you had with the efficacy and the medical food statements. Seppi333 (Insert 2¢) 19:39, 19 December 2016 (UTC)[reply]

Jytdog's use of "may" is much better than "can" based on my reading of the evidence. We have the concern that this stuff has not actually been studied in people with sarcopenia, we have the issue of the small number of peoples in the trials, and than we have the issue of other sources using more tentative language. Doc James (talk · contribs · email) 19:42, 19 December 2016 (UTC)[reply]

Have moved the marketing claims to the 4th paragraph.[4] Likely just needs one reference rather than 4 as all supported by PR Newswire Doc James (talk · contribs · email) 19:47, 19 December 2016 (UTC)[reply]

I've removed the link to sarcopenia in the lead sentence since you feel that this is an issue. Seppi333 (Insert 2¢) 19:48, 19 December 2016 (UTC)[reply]

That was not my issue and this does not address my concerns[5] Doc James (talk · contribs · email) 19:48, 19 December 2016 (UTC)[reply]

You said We have the concern that this stuff has not actually been studied in people with sarcopenia. I've removed sarcopenia from the lead and simply indicated it's people with age-related muscle loss, which is supported by the title of the meta-analysis and the demographics included in the meta-analysis. The modified sentence is almost identical to the sentence in the conclusion of the meta-analysis, with superficial wording differences. Why is that sentence still an issue? It's clearly not an overstatement of efficacy per the meta-anaylsis. Edit: the article says "HMB can inhibit the loss of lean body mass in individuals experiencing age-related muscle loss"; the meta-analysis says "Overall, this meta-analysis indicates that HMB can prevent lean body mass loss in older adults." What the meta-analysis says is stronger than what the article says because prevent means "completely avoid", whereas inhibit just means "reduce". I'm not okay with downplaying the efficacy anymore than that.Seppi333 (Insert 2¢) 19:51, 19 December 2016 (UTC)[reply]

Entire conclusion from the meta-analysis

From [6]:

5. Conclusion
Overall, this meta-analysis indicates that HMB can prevent lean body mass loss in older adults. But the effects of HMB on muscle strength and physical function appears to vary in different populations. Additional well-designed clinical studies are necessary to confirm the effectiveness of HMB in the prevention of loss of muscle strength and physical function.

@Doc James: What is your concern with that sentence, specifically, if the population samples included in the RCTs from that meta-analysis (link here) wasn't the issue? Seppi333 (Insert 2¢) 00:00, 20 December 2016 (UTC)[reply]

Seppi, above you wrote: " I've removed sarcopenia from the lead and simply indicated it's people with age-related muscle loss". That is not any change in meaning, right? Jytdog (talk) 01:54, 20 December 2016 (UTC)[reply]

@Jytdog: sarcopenia and age-related muscle loss aren't entirely synonymous. Sarcopenia is a medical diagnosis that involves the loss of lean body mass, whereas the loss of muscle mass associated with age is simply a phenomenon that typically starts to occur in the late 30s or mid-40s and accelerates with each additional decade. Before that point, the human body is on average in an anabolic state, and muscle growth tends to occur annually even without exercise. After that age range, the body is on average in a catabolic state, and muscle mass tends to decline on an annual basis. The meta-analysis included studies in which the samples contained primarily healthy older adults who did not have a diagnosis of sarcopenia. Some of the participants may have been sarcopenic, but to my knowledge none were diagnosed as such.

The fact that the participants in most of the studies were not diagnosed with sarcopenia is one of the issues that Doc James correctly pointed out earlier. We shouldn't say that the meta-analysis applies to adults diagnosed with sarcopenia. Its conclusion really only applies to older adults in general, almost all of whom experience annual losses in muscle mass if they don't perform resistance exercise on a regular basis. Seppi333 (Insert 2¢) 02:24, 20 December 2016 (UTC)[reply]

@Doc James: I'm pinging you to let you know that I've renominated this article and moved our discussion from the HMB talk page here. Seppi333 (Insert 2¢) 18:03, 1 January 2017 (UTC)[reply]

Comments by SlimVirgin

Comment. Seppi333, I'm not in a position to support or oppose this, but I wondered whether you'd consider moving the history to the top. It's interesting, it's short and it provides a gentle introduction. SarahSV ^(talk) 02:29, 7 January 2017 (UTC)[reply]
- @SlimVirgin: Sorry for the late reply. In order to satisfy FA criterion 2b (appropriate structure), the article conforms to the section layout specified in MOS:MED#Drugs, treatments, and devices/MOS:PHARM (these guidelines have identical provisions for medications and other drugs/biologically active substances - the latter is just more detailed). Unfortunately, these guidelines specify that the history section be placed more towards the end of the article. With that said, I'm not actually opposed to the idea of repositioning "History" as one of the first sections, but I'd prefer not to deviate from the MOS since I know for certain that some medical editors will take issue with me doing that. Seppi333 (Insert 2¢) 21:21, 11 January 2017 (UTC)[reply]

Coordinator note

Coordinator note: This nomination is in danger of stalling as we are without substantial comment when the review has been open for over a month. I would be tempted to archive, but I am aware that medical articles can be a little slow burning, and concerns have been raised in the past that we have archived too quickly. However, given that we have had no review yet, I think we need to see something happening in the next week if this review is to be kept open. Sarastro1 (talk) 12:43, 4 February 2017 (UTC)[reply]

@Sarastro1: This nomination reminds me so much of Wikipedia:Featured article candidates/Amphetamine/archive3. I have a feeling that this is going to require 5 FAC nominations before there's enough constructive reviewer feedback for this article to be promoted as well... In any event, please archive this nomination. I don't have the time to badger past/potential reviewers to comment on this nomination at the moment and Doc James is currently on vacation; consequently, I don't think it's particularly likely that there would be much activity in this nomination over the next 2 weeks if the nomination were kept open. Seppi333 (Insert 2¢) 20:45, 11 February 2017 (UTC)[reply]

Closing note: This candidate has been archived, but there may be a delay in bot processing of the close. Please see WP:FAC/ar, and leave the {{featured article candidates}} template in place on the talk page until the bot goes through. Sarastro1 (talk) 21:00, 13 February 2017 (UTC)[reply]

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.